Resilience and coping

فَإِنَّ مَعَ ٱلۡعُسۡرِ يُسۡرًا

So truly where there is hardship there is also ease

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ خُذُواْ حِذۡرَكُمۡ فَٱنفِرُواْ ثُبَاتٍ أَوِ ٱنفِرُواْ جَمِيعࣰ ا

You who believe, be on your guard. March [to battle] in small groups or as one body

بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِ In the Name of Allah, the Most Gracious, the Most Merciful. أَلَمْ نَشْرَحْ لَكَ صَدْرَكَ - وَوَضَعْنَا عَنكَ وِزْرَكَ - الَّذِي أَنقَضَ ظَهْرَكَ - وَرَفَعْنَا لَكَ ذِكْرَكَ - فَإِنَّ مَعَ الْعُسْرِ يُسْرًا - إِنَّ مَعَ الْعُسْرِ يُسْرًا - فَإِذَا فَرَغْتَ فَانصَبْ - وَإِلَىٰ رَبِّكَ فَارْغَب (1. Have We not opened your breast for you?)(2. And removed from you your burden.)(3. Which weighed down your back?)(4. And have We not raised high your fame?)(5. Verily, along with every hardship is relief,)(6. Verily, along with every hardship is relief.)(7. So when you have finished, devote yourself to Allah's worship.)(8. And to your Lord turn intentions and hopes.) The Meaning of opening the Breast Allah says, أَلَمْ نَشْرَحْ لَكَ صَدْرَكَ (Have We not opened your breast for you?) meaning, 'have We not opened your chest for you.' This means, 'We ill

Indeed, with difficulty and constraint, comes ease and options.

O you who believe take your precautions against your enemy that is be wary of him and be vigilant against him; then move forward prepare to fight him in companies in separate groups one raiding party followed by the next; or move forward all together in one assembly.

O you who believe! Take your precautions, and either go forth (on an expedition) in parties, or go forth all together (71)There is certainly among you he who would linger behind. If a misfortune befalls you, he says, "Indeed Allah has favored me in that I was not present among them. (72)But if a bounty comes to you from Allah, he would surely say ـ as if there had never been ties of affection between you and him, "Oh! I wish I had been with them; then I would have achieved a great success. (73)So fight those who trade the life of this world with the Hereafter, in the cause of Allah, and whoever fights in the cause of Allah, and is killed or gets victory, We shall bestow on him a great reward (74) The Necessity of Taking Necessary Precautions Against the Enemy Allah commands His faithful servants to take precautions against their enemies, by being prepared with the necessary weapons and

حَدَّثَنَا هَدَّابُ بْنُ خَالِدٍ، حَدَّثَنَا حَمَّادُ بْنُ سَلَمَةَ، ح وَحَدَّثَنِي زُهَيْرُ بْنُ حَرْبٍ، حَدَّثَنَا مُعَاذُ بْنُ مُعَاذٍ الْعَنْبَرِيُّ، ح وَحَدَّثَنِي مُحَمَّدُ بْنُ عَبْدِ الأَعْلَى، حَدَّثَنَا الْمُعْتَمِرُ، ح وَحَدَّثَنَا إِسْحَاقُ، بْنُ إِبْرَاهِيمَ أَخْبَرَنَا جَرِيرٌ، كُلُّهُمْ عَنْ سُلَيْمَانَ التَّيْمِيِّ، ح وَحَدَّثَنَا أَبُو كَامِلٍ، فُضَيْلُ بْنُ حُسَيْنٍ - وَاللَّفْظُ لَهُ - حَدَّثَنَا يَزِيدُ بْنُ زُرَيْعٍ، حَدَّثَنَا التَّيْمِيُّ، عَنْ أَبِي عُثْمَانَ، عَنْ أُسَامَةَ بْنِ زَيْدٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ قُمْتُ عَلَى بَابِ الْجَنَّةِ فَإِذَا عَامَّةُ مَنْ دَخَلَهَا الْمَسَاكِينُ وَإِذَا أَصْحَابُ الْجَدِّ مَحْبُوسُونَ إِلاَّ أَصْحَابَ النَّارِ فَقَدْ أُمِرَ بِهِمْ إِلَى النَّارِ وَقُمْتُ عَلَى بَابِ النَّارِ فَإِذَا عَامَّةُ مَنْ دَخَلَهَا النِّسَاءُ ‏"‏ ‏.‏

Usama b. Zaid reported that Allah's Messenger (way peace be upon him) said:I stood at the door of Paradise and I found that the overwhelming majority of those who entered therein was that of poor persons and the wealthy persons were detained to get into that. The denizens of Hell were commanded to get into Hell, and I stood upon the door of Fire and the majority amongst them who entered there was that of women

حَدَّثَنَا أَبُو كُرَيْبٍ، حَدَّثَنَا أَبُو أُسَامَةَ، عَنْ سَعِيدِ بْنِ أَبِي عَرُوبَةَ، سَمِعَ أَبَا رَجَاءٍ، عَنِ ابْنِ عَبَّاسٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم فَذَكَرَ مِثْلَهُ ‏.‏

This hadith is narrated likewise through another chain of transmitters

حَدَّثَنِي عَبْدُ اللَّهِ بْنُ مُحَمَّدٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ عَمْرٍو، حَدَّثَنَا زُهَيْرُ بْنُ مُحَمَّدٍ، عَنْ مُحَمَّدِ بْنِ عَمْرِو بْنِ حَلْحَلَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي سَعِيدٍ الْخُدْرِيِّ، وَعَنْ أَبِي هُرَيْرَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ مَا يُصِيبُ الْمُسْلِمَ مِنْ نَصَبٍ وَلاَ وَصَبٍ وَلاَ هَمٍّ وَلاَ حُزْنٍ وَلاَ أَذًى وَلاَ غَمٍّ حَتَّى الشَّوْكَةِ يُشَاكُهَا، إِلاَّ كَفَّرَ اللَّهُ بِهَا مِنْ خَطَايَاهُ ‏"‏‏.‏

Narrated Abu Sa`id Al-Khudri and Abu Huraira:The Prophet (ﷺ) said, "No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that

حَدَّثَنَا إِبْرَاهِيمُ بْنُ الْمُنْذِرِ، قَالَ حَدَّثَنِي مُحَمَّدُ بْنُ فُلَيْحٍ، قَالَ حَدَّثَنِي أَبِي، عَنْ هِلاَلِ بْنِ عَلِيٍّ، مِنْ بَنِي عَامِرِ بْنِ لُؤَىٍّ عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي هُرَيْرَةَ ـ رضى الله عنه ـ قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ مَثَلُ الْمُؤْمِنِ كَمَثَلِ الْخَامَةِ مِنَ الزَّرْعِ مِنْ حَيْثُ أَتَتْهَا الرِّيحُ كَفَأَتْهَا، فَإِذَا اعْتَدَلَتْ تَكَفَّأُ بِالْبَلاَءِ، وَالْفَاجِرُ كَالأَرْزَةِ صَمَّاءَ مُعْتَدِلَةً حَتَّى يَقْصِمَهَا اللَّهُ إِذَا شَاءَ ‏"‏‏.‏

Narrated Abu Huraira:Allah's Messenger (ﷺ) said, "The example of a believer is that of a fresh tender plant; from whatever direction the wind comes, it bends it, but when the wind becomes quiet, it becomes straight again. Similarly, a believer is afflicted with calamities (but he remains patient till Allah removes his difficulties.) And an impious wicked person is like a pine tree which keeps hard and straight till Allah cuts (breaks) it down when He wishes." (See Hadith No. 558, Vol)

حَدَّثَنَا عَبْدُ اللَّهِ بْنُ مَسْلَمَةَ بْنِ قَعْنَبٍ، حَدَّثَنَا سُلَيْمَانُ، - يَعْنِي ابْنَ بِلاَلٍ - عَنْ جَعْفَرٍ، عَنْ أَبِيهِ، عَنْ جَابِرِ بْنِ عَبْدِ اللَّهِ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم مَرَّ بِالسُّوقِ دَاخِلاً مِنْ بَعْضِ الْعَالِيَةِ وَالنَّاسُ كَنَفَتَهُ فَمَرَّ بِجَدْىٍ أَسَكَّ مَيِّتٍ فَتَنَاوَلَهُ فَأَخَذَ بِأُذُنِهِ ثُمَّ قَالَ ‏"‏ أَيُّكُمْ يُحِبُّ أَنَّ هَذَا لَهُ بِدِرْهَمٍ ‏"‏ ‏.‏ فَقَالُوا مَا نُحِبُّ أَنَّهُ لَنَا بِشَىْءٍ وَمَا نَصْنَعُ بِهِ قَالَ ‏"‏ أَتُحِبُّونَ أَنَّهُ لَكُمْ ‏"‏ ‏.‏ قَالُوا وَاللَّهِ لَوْ كَانَ حَيًّا كَانَ عَيْبًا فِيهِ لأَنَّهُ أَسَكُّ فَكَيْفَ وَهُوَ مَيِّتٌ فَقَالَ ‏"‏ فَوَاللَّهِ لَلدُّنْيَا أَهْوَنُ عَلَى اللَّهِ مِنْ هَذَا عَلَيْكُمْ ‏"‏ ‏.‏

Jabir b. Abdullah reported that Allah's Apostle (ﷺ) happened to walk through the bazar coming from the side of 'Aliya and the people were on both his sides. There he found a dead lamb with very short ears. He took hold of his ear and said:Who amongst you would like to have this for a dirham? They said: We do not like to have it even for less than that as it is of no use to us. He said: Do you wish to have it (free of any cost)? They said: By Allah, even if it were alive (we would not have liked to possess that), for there is defect in it as its ear is very short; now it is dead also. Thereupon Allah's Messenger (ﷺ) said: By Allah, this world is more insignificant in the eye of Allah than it (this dead lamb) is in your eye

حَدَّثَنِي مُحَمَّدُ بْنُ الْمُثَنَّى الْعَنَزِيُّ، وَإِبْرَاهِيمُ بْنُ مُحَمَّدِ بْنِ عَرْعَرَةَ السَّامِيُّ، قَالاَ حَدَّثَنَا عَبْدُ الْوَهَّابِ، - يَعْنِيَانِ الثَّقَفِيَّ - عَنْ جَعْفَرٍ، عَنْ أَبِيهِ، عَنْ جَابِرٍ، عَنِ النَّبِيِّ صلى الله عليه وسلم ‏.‏ بِمِثْلِهِ غَيْرَ أَنَّ فِي حَدِيثِ الثَّقَفِيِّ فَلَوْ كَانَ حَيًّا كَانَ هَذَا السَّكَكُ بِهِ عَيْبًا ‏.‏

Jabir reported Allah's Apostle (ﷺ) narrating a hadith like this with a slight variation of wording

ثم خاصية العقل واللب : التمييز بين مراتب المحبوبات والمكروهات بقوة العلم والتمييز وإيثار أعلى المحبوبين على أدناهما واحتمال أدنى المكروهين للتخلص من أعلاهما بقوة الصبر والثبات واليقين

وأمر المصاب بأنفع الأمور له وهو الصبر والاحتساب فإن ذلك يخفف مصيبته ويوفر أجره والجزع والتسخط والتشكى يزيد في المصيبة ويذهب الأجر

فالصبر مع نفسك و المصابرة بينك وبين عدوك و المرابطة الثبات وإعداد العدة وكما أن الرباط لزوم الثغر لئلا يهجم منه العدو فكذلك الرباط أيضا لزوم ثغر القلب لئلا يهجم عليه الشيطان فيملكه أو يخربه أو يشعثه

ويهيج أفراحهم قابلوه بالسكون والثبات والاستقرار حتى كأنه لم يهجم عليهم وقال كعب بن زهير في مدح المهاجرين :

الثالث اللزوم والثبات ومنه حب البعير وأحب إذا برك ولم يقم قال الشاعر

الركن الرابع: نفس الاحتساب، وله درجات وآداب.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors.: Objective: The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer. Methods: Four databases were systematically searched from inception to August 2020. Both qualitative an

Resilience and related factors in colorectal cancer patients: A systematic review.: Purpose: To explore resilience and its related factors in adult colorectal cancer patients. Methods: Three databases (CINAHL, Scopus and PubMed) were searched for literature published from January 2009 to February 2021 using the terms colorectal and resilience or resilient or resiliency. The review was registered with PROSPERO and followed the PRISMA statement guidelines. Results: The studies (n = 11) showed that most colorectal cancer patients exhibit moderate levels of resilience. Resilience w

Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review.: Purpose: The diagnosis of a life-threatening illness can be an extremely stressful, traumatic experience. However, many survivors report also various positive changes, referred in empirical literature as post-traumatic growth (PTG). Empirical studies that documented stress disorders and PTG in patients and survivors of life-threatening diseases are reviewed in three areas: Predictors of PTG, relationships between PTG and indicators of mental health and the impact of PTG on the process of convale

A systematic review of resilience in the physically ill.: Background: Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness. Objective: We conducted a systematic review of resilience and related concepts in the physically ill to determine factors associated with predicting or promoting resilience. Methods: An electronic search of PsychInfo, Medline, and CINAHL databases between 1950 and May 2009 was performed using the terms resilience, and various types of

Resilience in Caregivers: A Systematic Review.: Background: Resilience is a multidimensional construct that explains why people facing the consequences of adversity and stress can have a positive outcome, emphasizing adjustment to experiences that are perceived as threatening. Objective: The aim of this study is to review the construct of resilience and associated variables in caregivers of patients with chronic, advanced illness and at the end of life. Methods: The review included studies published between January 2009 and January 2019, usin

Feasibility and acceptability of a resilience training program for intensive care unit nurses.: Background: The critical nursing shortage is particularly apparent in specialty areas such as intensive care units (ICUs). Some nurses develop resilient coping strategies and adapt to stressful work experiences, mitigating the development of common maladaptive psychological symptoms. Objectives: To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants. Methods: In a randomized and controlled 12-week intervention stud

Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer.

Introduction: The present study evaluated intimacy as a mechanism for the effects of relationship-enhancing (self-disclosure, mutual constructive communication) and relationship-compromising communication (holding back, mutual avoidance, and demand-withdraw communication) on couples' psychological distress. Methods: Seventy-five men diagnosed with localized prostate cancer in the past year and their partners completed surveys about communication, intimacy, and distress. Results: Multi-level models with the couple as unit of analyses indicated that the association between mutual constructive communication, mutual avoidance, and patient demand-partner withdraw and distress could be accounted for by their influence on relationship intimacy. Intimacy did not mediate associations between self-disclosure, holding back, and partner demand-patient withdraw communication and distress. Discussion/…

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Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial.

Objectives: An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well-being and sense of meaning and purpose in life. In response to the need for short-term interventions to address spiritual well-being, we developed Meaning Centered Group Psychotherapy (MCGP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose in their lives, even as they approach the end of life. Methods: Patients with advanced (stage III or IV) solid tumor cancers (N=90) were randomly assigned to either MCGP or a supportive group psychotherapy (SGP). Patients were assessed before and after completing the 8-week intervention, and again 2 months after completion. Outcome assessment included measures of spiritual well-being, meaning, hopelessness, desire for death, optimism/pessimism, anxiety, depression and overall quality…

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Effects of family foundations on parents and children: 3.5 years after baseline.

This study investigated the ability of a psychosocial prevention program implemented through childbirth education programs to enhance the coparental and couple relationship, parental mental health, the parent-child relationship, and child outcomes. A sample of 169 heterosexual, adult couples expecting their first child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of eight classes delivered before and after birth, which was designed as a universal prevention program (i.e., applicable to all couples, not just those at high risk). Intent-to-treat analyses utilizing data collected from child age 6 months through 3 years indicated significant program effects on parental stress and self-efficacy, coparenting, harsh parenting, and children's emotional adjustment among all families, and maternal depression among coh…

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Evaluating the cognitive avoidance model of generalised anxiety disorder: impact of worry on threat appraisal, perceived control and anxious arousal.

Generalised anxiety disorder (GAD) is characterised by persistent and uncontrollable worry. According to the cognitive avoidance theory of GAD, worry may function as an affective dampening strategy motivated by intolerance of negative emotional states. By facilitating avoidance of more distressing cognitions and associated affect, worry is said to preclude modification of the fear representation in memory, maintaining threat associations and perpetuating further anxiety and worry. The present study evaluated these assumptions in a treatment-seeking GAD sample. Sixty-one participants were randomly allocated to conditions in which they were instructed to worry, imaginally process or relax in response to an anxiety trigger. Results supported the detrimental impact of worry, showing maintained threat expectancies and decreased control perceptions compared to other modes of processing. Howeve…

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Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention.

Objectives: To test the effects of an intervention that helps families manage distressing behaviors in family members with dementia. Design: Two-group randomized trial. Setting: In home. Participants: Two hundred seventy-two caregivers and people with dementia. Intervention: Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors, including communication and environmental factors and patient undiagnosed medical conditions (by obtaining blood and urine samples) and trained caregivers in strategies to modify triggers and reduce their upset. Between 16 and 24 weeks, three telephone contacts reinforced strategy use. Measurements: Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks. Secondary outcomes were caregiver well-being and management skills…

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Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial.

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to t…

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Engaging in imagery versus verbal processing of worry: Impact on negative intrusions in high worriers.

Chronic, excessive, and uncontrollable worry is the defining characteristic of generalised anxiety disorder. Worry largely consists of verbal thought and it has been postulated that this predominance of verbal thought in worry may contribute to its perseveration. In an investigation of this issue, high worriers were trained to engage in either imagery or verbal processing. Mentation was sampled before and after a five-minute period of worry during which participants engaged in either imagery of the worry topic or verbal processing of the worry topic. Verbal worry resulted in a significant increase in negative intrusions, consistent with previous research. Furthermore, imagery was associated with a decrease in negative intrusions. The results support the theory that the predominantly verbal nature of worry may be responsible for the uncontrollability and maintenance of worry.

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A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer.

Objective: To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis. Design: Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval. Main outcome measures: Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention. Results: No significant main effects of experimental condition were observed. A significant condition x social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusi…

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The feasibility and effectiveness of expressive writing for rural and urban breast cancer survivors.

Purpose/objectives: To determine the feasibility and effectiveness of implementing an in-home expressive-writing intervention among breast cancer survivors living in urban and rural areas. Design: Women who had completed radiation therapy were selected to participate in either expressive writing or a usual-care control condition. Setting: All materials were completed in the privacy of participants' homes. Sample: Of the 57 breast cancer survivors recruited, 40 participated in the writing intervention. An additional 40 women were assigned to the control group. Methods: Participants completed measures of physical and psychological health at two time points prior to writing and at two follow-up time points three and nine months after writing. Main research variables: Participation rates and physical and psychological health. Findings: Results showed that engaging in a single in-home writing…

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A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training.

In this comparative intervention study, 107 working individuals with above average levels of distress were randomly assigned to one of three conditions: acceptance and commitment therapy (ACT; n = 37); stress inoculation training (SIT; n = 37); or a waitlist control group (n = 33). The interventions were delivered to small groups in the workplace via two half-day training sessions. ACT and SIT were found to be equally effective in reducing psychological distress across a three month assessment period. Mediation analysis indicated that the beneficial impact of ACT on mental health resulted from an increase in psychological flexibility rather than from a change in dysfunctional cognitive content. Contrary to hypothesis, a reduction in dysfunctional cognitions did not mediate change in the SIT condition. Results suggest that the worksite may offer a useful, yet underutilised, arena for test…

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The effects of counting blessings on subjective well-being: a gratitude intervention in a Spanish sample.

This study examined a gratitude intervention repeating Emmons and McCullough study (2003) in a Spanish sample, Participants were randomly assigned to one of three conditions (gratitude, hassles and any event) and kept daily records during 2 weeks of gratitude, affect, quality of relationships, physical and subjective well-being. We added design features to assess the intervention long-term impact (follow-up measures), and to improve the design control (pre-treatment measures). Following the cited authors' analysis, i.e., comparing groups only in the post-test, we replicated their results, finding differences in positive affect and gratitude between the gratitude condition and the hassles condition. However, when including both the pre and the follow-up measures in the analysis, results were replicated only partially, as the difference in gratitude disappeared. Moreover, the difference in…

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An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales.

Purpose: The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to develop self-reported item banks for clinical research. The PROMIS pediatrics (aged 8-17) project focuses on the development of item banks across several health domains (physical function, pain, fatigue, emotional distress, social role relationships, and asthma symptoms). The psychometric properties of the anxiety and depressive symptom item banks are described. Methods: Participants (n = 1,529) were recruited in public school settings, hospital-based outpatient and subspecialty pediatrics clinics. The anxiety (k = 18) and depressive symptoms (k = 21) items were split between two test administration forms. Hierarchical confirmatory factor-analytic models (CFA) were conducted to evaluate scale dimensionality and local dependence. IRT analyses were then used to finalize item banks and short forms. Result…

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Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder.

A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully me…

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A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet.

Objective: This study evaluated the efficacy of a spiritually integrated treatment (SIT) for subclinical anxiety in the Jewish community. Method: One hundred and twenty-five self-reported religious Jewish individuals with elevated levels of stress and worry received SIT (n=36), progressive muscle relaxation (PMR, n=42), or a waitlist control condition (WLC, n=47). SIT and PMR participants accessed Internet-based treatment on a daily basis for a period of 2 weeks. All participants completed self-report assessments at pre-treatment (T1), post-treatment (T2), and 6-8-week follow-up (T3). Results: SIT participants reported large improvements in primary (stress and worry) and secondary (depression and intolerance of uncertainty) outcomes, and moderate improvements in spiritual outcomes (positive/negative religious coping; trust/mistrust in God). SIT participants reported greater belief in tre…

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Adjusting to death: the effects of mortality salience and self-esteem on psychological well-being, growth motivation, and maladaptive behavior.

This research builds on terror management theory to examine the relationships among self-esteem, death cognition, and psychological adjustment. Self-esteem was measured (Studies 1-2, 4-8) or manipulated (Study 3), and thoughts of death were manipulated (Studies 1-3, 5-8) or measured (Study 4). Subsequently, satisfaction with life (Study 1), subjective vitality (Study 2), meaning in life (Studies 3-5), positive and negative affect (Studies 1, 4, 5), exploration (Study 6), state anxiety (Study 7), and social avoidance (Study 8) were assessed. Death-related cognition (a) decreased satisfaction with life, subjective vitality, meaning in life, and exploration; (b) increased negative affect and state anxiety; and (c) exacerbated social avoidance for individuals with low self-esteem but not for those with high self-esteem. These effects occurred only when death thoughts were outside of focal at…

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Developmental cascade effects of the New Beginnings Program on adolescent adaptation outcomes.

Using data from a 6-year longitudinal follow-up sample of 240 youth who participated in a randomized experimental trial of a preventive intervention for divorced families with children ages 9-12, the current study tested alternative cascading pathways by which the intervention decreased symptoms of internalizing disorders, symptoms of externalizing disorders, substance use, and risky sexual behavior and increased self-esteem and academic performance in mid- to late adolescence (15-19 years old). It was hypothesized that the impact of the program on adolescent adaptation outcomes would be explained by progressive associations between program-induced changes in parenting and youth adaptation outcomes. The results supported a cascading model of program effects in which the program was related to increased mother-child relationship quality that was related to subsequent decreases in child in…

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Mental health promotion as a new goal in public mental health care: a randomized controlled trial of an intervention enhancing psychological flexibility.

Objectives: We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Methods: Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum-Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Results: Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness i…

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Prevalence and severity of college student bereavement examined in a randomly selected sample.

The authors used stratified random sampling to assess the prevalence and severity of bereavement in college undergraduates, providing an advance over findings that emerge from convenience sampling methods or from anecdotal observations. Prior research using convenience sampling indicated that 22% to 30% of college students are within 12 months of having experienced the death of a family member or friend. Using an ethnically diverse sample from a private, Midwestern university, 118 randomly selected students answered demographic and life experience questions and indicated whether a family member or friend had died within the last 24 months. Those who reported experiencing such a loss also completed the PG-13, a questionnaire used to assess prolonged grief disorder. Results indicated that 30% of the sample was within 12 months of experiencing a loss and 39% was within 24 months of experien…

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Alexithymia and cancer pain: the effect of psychological intervention.

Background: Alexithymia is likely to be involved in the pain experience of cancer patients, but the extent to which psychological interventions may modify both pain and alexithymia is unclear. Methods: A group of 52 consecutive cancer patients were enrolled in a 6-month multicomponent psychological intervention trial, and compared to 52 control patients who received standard medical care. Validated scales for pain, alexithymia, coping with disease, illness behavior, psychological distress, and psychosocial functioning were administered at baseline and 6 months later. Results: Pain was strongly associated with alexithymia and several psychological dimensions. Although at baseline patients in the intervention group had worse psychological and somatic health, at follow-up their level of pain intensity, alexithymia, and somatic concerns had significantly improved compared to control patients…

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Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.

Context: There are few randomized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer. Objective: To determine the effect of a nursing-led intervention on quality of life, symptom intensity, mood, and resource use in patients with advanced cancer. Design, setting, and participants: Randomized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural, National Cancer Institute-designated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont. Interventions: A multicomponent, psychoeducational intervention (Project ENABLE [Educate, Nurture, Advise, Before Life Ends]) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion …

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How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal.

It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression grou…

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Partner-assisted emotional disclosure for patients with gastrointestinal cancer: results from a randomized controlled trial.

Background: For patients with cancer who are married or in an intimate relationship, their relationships with their partners play a critical role in their adaptation to illness. However, cancer patients and their partners often have difficulty in talking with each other about their cancer-related concerns. Difficulties in communication ultimately may compromise both the patient-partner relationship and the patient's psychological adjustment. The current study tested the efficacy of a novel partner-assisted emotional disclosure intervention in a sample of patients with gastrointestinal (GI) cancer. Methods: One hundred thirty patients with GI cancer and their partners were assigned randomly to receive 4 sessions of either partner-assisted emotional disclosure or a couples cancer education/support intervention. Patients and partners completed measures of relationship quality, intimacy with…

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Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions.

Aims: The purpose of this randomized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men's resolution of depression and grief during the first year after miscarriage. Methods: Three hundred forty-one couples were randomly assigned to nurse caring (NC) (three counseling sessions), self-caring (SC) (three video and workbook modules), combined caring (CC) (one counseling session plus three SC modules), or control (no treatment). Interventions, based on Swanson's Caring Theory and Meaning of Miscarriage Model, were offered 1, 5, and 11 weeks after enrollment. Outcomes included depression (CES-D) and grief, pure grief (PG) and grief-related emotions (GRE). Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework. Results: Bayesian odds (BO) ranging from 3.0 to 7.9 …

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Personality, stressful life events, and treatment response in major depression.

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those l…

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Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning.

Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related…

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